Healthcare News & Insights

How to spot & handle dementia in older hospital patients

When providing care to elderly patients, hospital staff need to take multiple factors into consideration, since many seniors have a variety of medical conditions. It’s especially important to be aware of whether a patient has dementia so the person can be treated accordingly. 

ThinkstockPhotos-86529245Dementia is on the rise in elderly patients. According to a news brief from the Pennsylvania Patient Safety Authority, Alzheimer’s disease is the most common form of dementia – it makes up between 60% to 80% of cases.

In all, an estimated 5.1 million people are currently living with Alzheimer’s disease, and the numbers are expected to rise as baby boomers age.

Even more challenging: Older patients who have the condition often don’t have a formal diagnosis of dementia or Alzheimer’s. Here’s why: It’s tough for doctors to distinguish between normal signs of aging and symptoms of dementia, especially in the early stages of cognitive decline.

That means hospital staff may be talking to a patient who has dementia without even being aware there are issues. Many clinicians aren’t trained to properly identify dementia, or interact with elderly patients who have cognitive issues. And that can significantly compromise the quality of care the patient receives.

Plus, because many elderly patients receive Medicare, hospitals are judged based on their health outcomes. So problems with caring for dementia patients can directly hurt their bottom lines.

Issues to watch

Per the Patient Safety Authority, there are five significant areas where issues arise when treating hospital patients who have dementia:

  1. Failure to recognize pre-existing dementia in patients. The first step is knowing how to assess if a patient has dementia, whether the condition is listed in the person’s medical chart or not. Several screening tools are available for providers to use on older patients, including the 10-minute Mini-Mental State Examination (MMSE), the Clock Drawing Test and the Mini-Cog.
  2. Failure to assess competence and decision-making capacity. Providers who aren’t aware of a patient’s dementia may assume that the person fully understands his treatment and can make his own decisions about options.
  3. Failure to identify a reliable historian or surrogate decision maker. Even if clinicians suspect a patient has a form of dementia, they may not always find out who they should discuss the person’s treatment and medical history with so they can get confirmation.
  4. Failure to contact a reliable historian or surrogate decision maker. The clinician may assume that patients are able to relay details about their medical history or consent to treatment themselves, when in fact, it’s necessary for clinicians to contact a family member or a designated decision maker instead.
  5. Failure to communicate a patient’s dementia diagnosis, competence and decision-making capacity. Every member of the clinical team may not be aware of a patient’s cognitive status. Miscommunication among staff may lead to treatment changes that occur without proper consent or other problems with patient care.

One way clinicians can cut down on these problems is by clearly communicating with the patient’s family. Family members can give insight into the patient’s normal mental state and behaviors, which makes it easier for providers to determine whether something’s amiss.

It may also be helpful if hospital staff can easily see if a patient has dementia through a visual cue, such as a special bracelet similar to those used for patients who are fall risks. That way, they can immediately know how to address the patient’s needs.

Overall, it’s better to err on the side of caution and make a dementia screening a standard part of your hospital’s protocol for patient care. It only takes a few extra minutes, but it could significantly improve the treatment your facility provides to elderly patients.

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